ER physicians settle squabble on certification

ER doctors settle squabble on certification

TODD ACKERMAN, HOUSTON CHRONICLE

Published 5:30 am, Saturday, October 30, 2010

AUSTIN — In a matter that competing camps of doctors warned would affect the welfare of patients, Texas' medical regulatory agency Friday changed its rules to prevent future emergency physicians from advertising themselves as board-certified if they haven't completed supervised training in the specialty.

But the Texas Medical Board also put in place a compromise grandfathering in those emergency doctors certified before Sept. 1, 2010, by an alternative association that substitutes ER experience for residency training. The association includes about 175 doctors in Texas.

"I can't predict the future effect this rule change will have, but the intent has nothing to do with whom hospitals employ," said Texas Medical Board Chairwoman Dr. Melinda McMichael, refuting the alternative association's claim it would lead to hospitals requiring ER doctors be board-certified. "It's strictly about advertising."

Board-certified?

The board's 12-6 vote ends a yearlong battle that pitted emergency doctors against one another. Traditionally certified doctors said allowing physicians without proper training to advertise themselves as board-certified would mislead the public.

Doctors certified by the alternative association said the rule change would cost some of them their jobs and rob the state of some manpower it relies on to staff emergency departments, particularly those in the state's rural areas.

Neither side was happy with the compromise.

The fight's primary combatants are the American Board of Medical Specialties, a 76-year-old association that in 1988 began requiring emergency doctors, a relatively new specialty at the time, to do a three-year residency; and the American Board of Physician Specialties, a younger association that in 1989 began certifying doctors who never did an emergency medicine residency but had worked in an ER five or more years.

The meeting drew national attention to a conflict now spreading to other states. One observer called Texas a bellwether for the rest of the U.S. Another predicted the war will last another generation.

For two hours, a packed house of mostly doctors took turns testifying, occasionally emotionally, before the state regulatory agency. It was the fourth such public hearing .

Shortage of physicians

"I'd love to have some residency-trained emergency doctors in my department, but another year went by and I'm still not seeing any," said Dr. Daniel Garza of Cleveland. "We need another plan to provide the doctors we're short on. This is that other plan."

Dr. Otto Marquez, a Dallas-area emergency physician, said "the board should be protecting patients, not taking sides in a turf war." Accusing the ABMS of trying to kill the ABPS, he said the board has gotten in "the middle of a food fight that's been going on for 20 years."

Dr. Sandy Schneider, president of the American College of Emergency Physicians, denied the issue puts the jobs of doctors who haven't completed an emergency residency at risk, noting that many doctors practice in ERs and are not board certified.

The rule changes must be published in the Texas Register before they become effective and can be enforced. Medical board officials said that would probably be in December or January.

Bruce Catton, the American Board of Physician Specialties' director of governmental affairs, said it will be two weeks to a month before the association decides on its next step but didn't rule out legal action.

The association sued in 2007, alleging the New York Department of Health was illegally barring its physicians from listing themselves as board certified online.